This entry provides an overview of the state of health care in the United States. Service delivery problems such as access and affordability issues are examined, and health care disparities and the populations affected are identified. A discussion of two primary government-sponsored health care programs—Title XVIII (Medicare) and Title XIX (Medicaid), and the Patient Protection and Affordable Health Care Act—are reviewed along with various health care programs and major existing service delivery systems. Ethical conflicts in providing health care, and new directions and challenges are discussed, along with future roles for social workers.
Larry D. Icard, Jacqueline J. Lloyd, and Gisoo Barnes
HIV/AIDS has introduced an array of issues and needs for children, youth, and their families. Family-focused interventions have emerged as a viable strategy for researchers and practitioners seeking effective and appropriate responses for the prevention, treatment, and care of children, youth, and families affected by HIV/AIDS. This discussion provides an overview of the epidemiology of HIV infection among children and youth, and highlights common elements and trends in the development, implementation, and testing of family-focused interventions. The discussion concludes with a commentary on areas for future attention.
Susan F. Allen and Elizabeth M. Tracy
Home visiting and home-based intervention are two strategies used by social workers when working with individuals or families in direct practice. The basic rationale for home-based work is the benefit to social workers’ assessments and understanding of clients, as well as the benefit of more relevant practice with families who are seen in the setting where difficulties are occurring. Home-based interventions have been shown to be effective in improving health and decreasing family discord. When visiting the home, the social worker has the added responsibility of respecting the privacy of families as a guest in their homes.
James C. Raines
Learning disabilities (LD) are the most common disability in public schools. Since 1975, students with learning disabilities have been eligible for a free appropriate public education, including special services such as school social work. Students with LD may be diagnosed via standardized achievement measures and clinical assessment. Despite 40 years of progress, the evidence suggests that students with LD still feel stigmatized and finish college and enter the workplace at a rate much lower than their nondisabled peers. School social workers can assist students with learning disabilities by assessing their self-esteem and social skills and then providing appropriate intervention. Self-esteem interventions should target students with LD, their parents, and their peers in the least restrictive environment. Social skills interventions may target students with LD as a separate group or provide those skills as part of universal inclusive education aimed at all children in the classroom.
Social workers working with individuals with intellectual disabilities and their families require an understanding of the disabilities themselves as well as the larger context of disability in society. Individuals with disabilities face particular risks for poverty and poor healthcare, and it is essential for social workers to understand the complex web of social services available. Furthermore, social workers often work not only with the person with a disability but also with their caregiving families.
Judith G. Gonyea
As a result of rising life expectancies, America’s older population is itself aging. The U.S. Census Bureau projections suggest that by the middle of the 21st century, more than 40% of Americans aged 65 and older can expect to live to at least the age of 90. Although the oldest-old is a diverse population, advanced old age is associated with a greater risk of experiencing economic hardship, disabling illnesses or health conditions, and social isolation. A growing public policy challenge will be ensuring the economic well-being, the health, and the dignity of society’s very oldest citizens.
Rosalie A. Kane
Long-term care (LTC), also called long-term support services, refers to personal care and services for people of all ages who cannot perform daily activities unaided. This entry reviews trends across LTC settings—nursing homes, assisted living, and consumers' own homes, emphasizing efforts since 1990 to downsize nursing homes and expand community services, while transforming the remaining nursing home sector into caring communities with individualized services and improved living conditions. Key themes include sustaining a frontline work force, developing a cross-disability unified agenda, defining and assuring quality, and ethical issues in balancing safety and autonomy. Opportunities for social work leadership in LTC abound.
Valire Carr Copeland and Daniel Hyung Jik Lee
Social reform efforts of the settlement-house movement have provided, in part, the foundation for today’s Maternal and Child Health Bureau’s policies, programs, and services. Planning, implementing, and evaluating policies and programs that affect the health and well-being of mothers and children require a multidisciplinary approach. Social workers, whose skills encompass direct services, advocacy, planning and research, community development, and administration, have a critical role to play in improving the health outcomes of maternal and child populations.
Kelli Godfrey and David Albright
Although there are many definitions of military social work, this article primarily focuses on social work by uniformed personnel within the United States military. Social work with military and veteran-connected populations is also done by civilian professionals.
The history of military social work in the United States is rooted in the civilian professional social work community and is a microcosm of that sector. Military social work has a rich history of providing services to military men and women and their families during periods of peace, conflict, and national crises. Military social workers have been involved in humanitarian operations and have participated in multinational peace-keeping operations. Social work in the Army, Navy, and Air Force is tailored to the mission of their particular service. However, joint operations between the services are becoming more frequent. Military social workers adhere to the National Association of Social Workers (NASW) code of ethics while providing service to an institution with its own unique culture, standards, and values. The role of military social workers has expanded since the Global War on Terrorism began, in 2001.
Military social work encompasses a wide variety of skills, performed by social workers who are both civilian and military, ranging from crisis to working with families. Military social work is unique and often faces ethical dilemmas even though military social workers still follow the National Association of Social Workers’ Code of Ethics. The history of military social work dates back to the early 1940s, but has evolved with the needs of military members and their families. The Army, Air Force, and Navy all have social workers, both civilian and those who wear the uniform. Due to the number of veterans and military families living throughout the United States, and seeking care in community settings, recommendations to establish competencies for social workers working with military and veteran-connected populations is underway.
David W. Springer and Kathleen A. Casey
Rehabilitation is a complex, multidimensional approach within health care that uses an interdisciplinary model of specialized services. The comprehensive treatment team generally includes medical specialists and therapists who specialize in physical therapy, occupational therapy, speech therapy, cognitive therapy, psychology, and recreational therapy. Social workers play a key role in the treatment team, particularly in care coordination, discharge planning, and community reintegration. Trends in comprehensive medical rehabilitation will continue to be significantly influenced by forces within the larger health-care arena. Technological advancements and the social trend toward health and fitness offer great promise for the improvement and expansion of rehabilitation services.
Lauren B. Gates
Vocational rehabilitation (VR) services, provided through a jointly funded state–federal rehabilitation system and available in each state, help people with disabilities prepare for, secure, and sustain employment. Since 1920, VR Programs have helped 10 million individuals with disabilities reach employment. Anyone with a mental or physical disability is eligible for VR services. While a range of services is provided, the services most consistent with VR goals are those, such as supported employment, that promote full integration into community life. Social workers are essential to community-based VR services; however, a challenge for the profession is to assume new roles to meet best practice vocational standards.